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Abdelhack M, Tripathi S, Chen Y, Avidan MS, King CR. Social vulnerability and surgery outcomes: a cross-sectional analysis. BMC Public Health 2024; 24:1907. [PMID: 39014400 PMCID: PMC11253435 DOI: 10.1186/s12889-024-19418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Post-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. Socioeconomic conditions have been established as social determinants of health. However, their contribution relating to postoperative complications is still unclear as it can be heterogeneous based on community, type of surgical services, and sex and gender. Uncovering these relations can enable improved public health policy to reduce such complications. METHODS In this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We collected electronic health records data from over 50,000 surgeries that happened between 2012 and 2018 at a quaternary health center in St. Louis, Missouri, United States and the corresponding zip code of the patients. We built statistical logistic regression models of postsurgical complications with the social vulnerability index of the tract consisting of the zip codes of the patient as the independent variable along with sex and race interaction. RESULTS Our sample from the St. Louis area exhibited high variance in social vulnerability with notable rapid increase in vulnerability from the south west to the north of the Mississippi river indicating high levels of inequality. Our sample had more females than males, and females had slightly higher social vulnerability index. Postoperative complication incidence ranged from 0.75% to 41% with lower incidence rate among females. We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection. Those associations disappeared when controlling for general health and comorbidities. CONCLUSIONS Our results indicate that social vulnerability measures such as socioeconomic status and housing conditions could affect postsurgical outcomes through preoperative health. This suggests that the domains of preventive medicine and public health should place social vulnerability as a priority to achieve better health outcomes of surgical interventions.
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Affiliation(s)
- Mohamed Abdelhack
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Sandhya Tripathi
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Yixin Chen
- Department of Computer Science, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher R King
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
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McKechnie T, Ramji K, Saddik M, Leitch J, Farooq A, Patel S, Doumouras A, Parpia S, Eskicioglu C, Bhandari M. PReoperative very low-Energy diets for obese PAtients undergoing non-bariatric surgery Randomized Evaluation (PREPARE): a protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2024; 10:82. [PMID: 38773543 PMCID: PMC11106982 DOI: 10.1186/s40814-024-01511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/14/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Patients with obesity presenting in need of surgical intervention are at 2-to-sixfold higher risk of prolonged hospitalization, infectious morbidity, venous thromboembolism, and more. To mitigate some of these concerns, prescribed preoperative weight loss via very low-energy diets (VLEDs) has become a standard of care for patients with obesity undergoing bariatric surgery. While VLEDs have become standard prior to bariatric surgery, their application in other surgical settings remains limited. A large, definitive trial is required to resolve the uncertainty surrounding their use in these patients. Prior to a definitive trial to compare the efficacy of VLEDs in patients with obesity undergoing major non-bariatric surgery, we require a pilot trial. We argue a pilot trial will provide the following critical feasibility insights: (1) assessment of recruitment ability, (2) evaluation of adherence to VLED regimens, and (3) assessment of our ability follow patients completely. METHODS The proposed trial will be a multi-center, surgeon, outcome assessor, and data-analyst blinded, parallel pilot randomized controlled trial (RCT). Patients older than 18 years of age with a body mass index (BMI) of greater than 30 kg/m2 undergoing major elective non-bariatric surgery will be eligible for inclusion. Consecutive patients will be allocated 1:1 according to a computer-generated randomization schedule. Randomization will be stratified by center and will employ randomly permutated blocks. All patients in the intervention group will receive standard patient counseling on weight loss and an active VLED protocol. The preoperative VLED protocol will utilize commercially available weight loss products for three weeks preoperatively. The primary outcomes (randomization percentage, recruitment rate, intervention adherence, follow-up completion, network development) will assess feasibility. Descriptive statistics will be used to characterize the study sample. DISCUSSION The PREPARE pilot RCT will aim to provide feasibility and safety data that will allow for the successful completion of the definitive PREPARE trial that has the potential to provide practice changing data pertaining to the regular use of VLEDs as a means of pre-habilitation for patients with obesity undergoing major non-bariatric surgery. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov (reference #NCT05918471) on June 23, 2023.
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Affiliation(s)
- Tyler McKechnie
- Department of Surgery, Division of General Surgery, McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4L8, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| | - Karim Ramji
- Department of Surgery, Division of General Surgery, McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4L8, Canada
- Department of Surgery, Division of General Surgery, St. Joseph Healthcare, Hamilton, ON, Canada
| | - Maisa Saddik
- Department of Surgery, Division of General Surgery, McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4L8, Canada
| | - Jordan Leitch
- Department of Anesthesia and Perioperative Medicine, Queen's University, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Ameer Farooq
- Department of Surgery, Division of General Surgery, Queen's University, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Sunil Patel
- Department of Surgery, Division of General Surgery, Queen's University, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Aristithes Doumouras
- Department of Surgery, Division of General Surgery, McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4L8, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Surgery, Division of General Surgery, St. Joseph Healthcare, Hamilton, ON, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Department of Surgery, Division of General Surgery, McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4L8, Canada
- Department of Surgery, Division of General Surgery, St. Joseph Healthcare, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, ON, Canada
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Aguilar M. My Big Fat Coronary Bypass Surgery: Sex, Obesity, and Postoperative Atrial Fibrillation. Can J Cardiol 2024:S0828-282X(24)00292-7. [PMID: 38579962 DOI: 10.1016/j.cjca.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024] Open
Affiliation(s)
- Martin Aguilar
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
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Chand S, Patel J, Tripathi A, Thapa S, Frishman WH, Aronow WS. Exploring the Intricate Interplay Between Obesity and Atrial Fibrillation: Mechanisms, Management, and Clinical Implications. Cardiol Rev 2024:00045415-990000000-00195. [PMID: 38230951 DOI: 10.1097/crd.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Atrial fibrillation (AF) stands as a prevalent and escalating cardiac arrhythmia in the United States, with obesity emerging as a prominent modifiable risk factor. This article explores the intricate relationship between obesity and AF, delving into the multifaceted pathophysiological mechanisms linking the 2 conditions. Various factors, such as autonomic dysfunction, left atrial stretch, inflammation, and hormonal imbalances, contribute to the initiation and perpetuation of AF in obese individuals. The Atrial Fibrillation Better Care pathway, emphasizing lifestyle modifications and weight loss strategies, emerges as a practical guideline for managing AF in obesity. This comprehensive review underscores the critical role of obesity as a significant modifiable risk factor for AF, urging a proactive approach to its management. Implementing the Atrial Fibrillation Better Care approach, focusing on encouraging physical activity, promoting healthy dietary habits, and raising awareness about the risks associated with obesity prove essential in preventing and mitigating the burden of AF in the obese population.
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Affiliation(s)
- Swati Chand
- From the Departments of Cardiology
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Jay Patel
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Ashish Tripathi
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Sangharsha Thapa
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - William H Frishman
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- From the Departments of Cardiology
- Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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Jiang S, Liao X, Chen Y, Li B. Exploring postoperative atrial fibrillation after non-cardiac surgery: mechanisms, risk factors, and prevention strategies. Front Cardiovasc Med 2023; 10:1273547. [PMID: 38130687 PMCID: PMC10733488 DOI: 10.3389/fcvm.2023.1273547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Atrial fibrillation (AF) stands as the most prevalent persistent arrhythmia and a common complication after surgical procedures. Although the majority of non-cardiac surgery patients experience postoperative AF (POAF) and the condition is typically self-limited and asymptomatic, its detrimental impact on patient outcomes, prolonged hospitalization, and heightened risk of stroke and overall mortality has become increasingly evident. Of significant concern, POAF emerges as a noteworthy risk factor for stroke, myocardial infarction, and mortality in comparison to patients with non-surgical atrial fibrillation. Multiple studies have corroborated the association between POAF and an elevated risk of stroke and mortality. The development of postoperative atrial fibrillation is multifactorial, with the inflammatory response being a primary contributor; additionally, factors such as hypovolemia, intraoperative hypotension, anemia, trauma, and pain can trigger POAF. Risk factors for POAF in non-cardiac surgery primarily relate to age, hypertension, obesity, prior cardiac disease, obstructive sleep apnea, and male sex. Prophylactic treatment with β-blockers, amiodarone, or magnesium has demonstrated efficacy, but further trials are warranted, especially in high-risk populations. This review provides an account of the incidence rate, pathophysiology, and prognosis of atrial fibrillation after non-cardiac surgery, elucidates the underlying mechanisms of its occurrence, and explores various preventive strategies investigated in this domain.
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Affiliation(s)
- Shengjie Jiang
- Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | | | | | - Binfei Li
- Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
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Abdelhack M, Tripathi S, Chen Y, Avidan MS, King CR. Social Vulnerability and Surgery Outcomes: A Cross-sectional Analysis. RESEARCH SQUARE 2023:rs.3.rs-3580911. [PMID: 38077013 PMCID: PMC10705703 DOI: 10.21203/rs.3.rs-3580911/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Background Post-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. However, the socioeconomic factors that relate to postoperative complications are still unclear as they can be heterogeneous based on communities, types of surgical services, and sex and gender. Methods In this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We built statistical logistic regression models of postsurgical complications with social vulnerability index as the independent variable along with sex interaction. Results We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection. Conclusions Our results indicate that social vulnerability measures such as socioeconomic status and housing conditions could be related to health outcomes. This suggests that the domain of preventive medicine should place social vulnerability as a priority to achieve its goals.
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Affiliation(s)
- Mohamed Abdelhack
- Department of Anesthesiology, Washington University School of Medicine, St. Louis MO
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON
| | - Sandhya Tripathi
- Department of Anesthesiology, Washington University School of Medicine, St. Louis MO
| | - Yixin Chen
- Department of Computer Science, Washington University in St. Louis, St. Louis MO
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis MO
| | - Christopher R King
- Department of Anesthesiology, Washington University School of Medicine, St. Louis MO
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Schram Serban C, de Groot NMS. Impact of Obesity on Atrial Electrophysiological Substrate. J Cardiovasc Dev Dis 2023; 10:342. [PMID: 37623355 PMCID: PMC10455641 DOI: 10.3390/jcdd10080342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background. Obesity is a well-established worldwide recognised risk factor for atrial fibrillation (AF). Prior review papers reported on the associations between obesity and AF development, but not on the relation between obesity and atrial electrophysiology. We therefore conducted a systematic review to describe the current knowledge of the characteristics of the atrial electrophysiological substrate in obese individuals and how they relate to the development of AF. (2) Methods. A search was conducted in Pubmed, Embase, and the Cochrane Library for publications evaluating the impact of obesity on atrial electrophysiology, electrical substrates, and their relation to the development of AF. (3) Results. A systematic literature search retrieved 477 potential publications based on the inclusion criteria; 76 full-text articles were selected for the present systematic review. The literature demonstrated that obesity predisposes to not only a higher AF incidence but also to more extensive atrial electrophysiological abnormalities increasing susceptibility to AF development. (4) Conclusion. Obesity may predispose to an overall increase in atrial electropathology, consisting of an increase in the slowing of the conduction, conduction block, low-voltage areas, and complex fractionated electrograms. To determine the impact of obesity-induced atrial electrical abnormalities on the long-term clinical outcome, further prospective studies are mandatory.
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Affiliation(s)
- Corina Schram Serban
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Natasja M. S. de Groot
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
- Department of Microelectronics, Circuits and Systems, Faculty of Electrical Engineering, Mathematics and Computer Sciences, Delft University of Technology, 2628 CD Delft, The Netherlands
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Yamagishi S, Okamura Y, Kang W, Shindate M, Kochi M, Mitsuka Y, Watabe M, Yoshida N, Ikarashi M, Yamazaki S, Aramaki O, Nakayama H, Moriguchi M, Higaki T, Yamashita H. Impact of Sarcopenic Obesity on Severe Postoperative Complications in Patients with Gastric Cancer Undergoing Gastrectomy. Dig Surg 2023; 40:143-152. [PMID: 37527628 DOI: 10.1159/000531797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/15/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Several studies have indicated that sarcopenia affects the short- and long-term outcomes of cancer patients, including those with gastric cancer. In recent years, sarcopenic obesity and its effects have been reported in cancer patients. This study aimed to evaluate the impact of sarcopenic obesity on postoperative complications in patients with gastric cancer undergoing gastrectomy. METHODS This single-center, retrospective study included 155 patients who underwent curative gastrectomy for gastric cancer from January 2015 to July 2021. Sarcopenia was defined by the psoas muscle index (<6.36 cm2/m2 in men and <3.92 cm2/m2 in women), which measures the iliopsoas muscle area at the lumbar L3 level using computed tomography. Obesity was defined by body mass index (≥25). Patients with both sarcopenia and obesity were defined as the sarcopenic obesity group and others as the non-sarcopenic obesity group. Severe postoperative complications were defined as Clavien-Dindo classification grade IIIa or higher. RESULTS Of the 155 patients, 26 (16.8%) had sarcopenic obesity. The incidence of severe postoperative complications was significantly higher in the sarcopenic obesity group (30.8% vs. 10.9%; p = 0.014). Multivariate analysis indicated that sarcopenic obesity was an independent risk factor for severe postoperative complications (odds ratio, 3.950; 95% confidence interval, 1.390-11.200; p = 0.010). CONCLUSION Sarcopenic obesity is an independent risk factor for severe postoperative complications.
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Affiliation(s)
- Shunsuke Yamagishi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan,
| | - Yukiyasu Okamura
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Woodae Kang
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Ichikawa Hospital, Chiba, Japan
| | - Masataka Shindate
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsugu Kochi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Mitsuka
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Megumu Watabe
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Nao Yoshida
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masahito Ikarashi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shintaro Yamazaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Aramaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hisashi Nakayama
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masamichi Moriguchi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tokio Higaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroharu Yamashita
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
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Impact of obesity on post-operative arrhythmias after congenital heart surgery in children and young adults. Cardiol Young 2022; 32:1820-1825. [PMID: 34986912 PMCID: PMC9256859 DOI: 10.1017/s1047951121005114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Obesity increases the risk of post-operative arrhythmias in adults undergoing cardiac surgery, but little is known regarding the impact of obesity on post-operative arrhythmias after CHD surgery. METHODS Patients undergoing CHD surgery from 2007 to 2019 were prospectively enrolled in the parent study. Telemetry was assessed daily, with documentation of all arrhythmias. Patients aged 2-20 years were categorised by body mass index percentile for age and sex (underweight <5, normal 5-85, overweight 85-95, and obese >95). Patients aged >20 years were categorised using absolute body mass index. We investigated the impact of body mass index category on arrhythmias using univariate and multivariate analysis. RESULTS There were 1250 operative cases: 12% underweight, 65% normal weight, 12% overweight, and 11% obese. Post-operative arrhythmias were observed in 38%. Body mass index was significantly higher in those with arrhythmias (18.8 versus 17.8, p = 0.003). There was a linear relationship between body mass index category and incidence of arrhythmias: underweight 33%, normal 38%, overweight 42%, and obese 45% (p = 0.017 for trend). In multivariate analysis, body mass index category was independently associated with post-operative arrhythmias (p = 0.021), with odds ratio 1.64 in obese patients as compared to normal-weight patients (p = 0.036). In addition, aortic cross-clamp time (OR 1.007, p = 0.002) and maximal vasoactive-inotropic score in the first 48 hours (OR 1.03, p = 0.04) were associated with post-operative arrhythmias. CONCLUSION Body mass index is independently associated with incidence of post-operative arrhythmias in children after CHD surgery.
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Wang P, Wang S, Ma Y, Li H, Liu Z, Lin G, Li X, Yang F, Qiu M. Sarcopenic obesity and therapeutic outcomes in gastrointestinal surgical oncology: A meta-analysis. Front Nutr 2022; 9:921817. [PMID: 35938099 PMCID: PMC9355157 DOI: 10.3389/fnut.2022.921817] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSarcopenic obesity (SO) has been indicated as a scientific and clinical priority in oncology. This meta-analysis aimed to investigate the impacts of preoperative SO on therapeutic outcomes in gastrointestinal surgical oncology.MethodsWe searched the PubMed, EMBASE, and Cochrane Library databases through March 4th 2022 to identify cohort studies. Endpoints included postoperative complications and survival outcomes. Newcastle Ottawa Scale was used for quality assessment. Heterogeneity and publication bias were assessed. Subgroup analyses and sensitivity analyses were performed.ResultsTwenty-six studies (8,729 participants) with moderate to good quality were included. The pooled average age was 65.6 [95% confidence interval (CI) 63.7–67.6] years. The significant heterogeneity in SO definition and diagnosis among studies was observed. Patients with SO showed increased incidences of total complications (odds ratio 1.30, 95% CI: 1.03–1.64, P = 0.030) and major complications (Clavien-Dindo grade ≥ IIIa, odds ratio 2.15, 95% CI: 1.39–3.32, P = 0.001). SO was particularly associated with the incidence of cardiac complications, leak complications, and organ/space infection. SO was also predictive of poor overall survival (hazard ratio 1.73, 95% CI: 1.46–2.06, P < 0.001) and disease-free survival (hazard ratio 1.41, 95% CI: 1.20–1.66, P < 0.001). SO defined as sarcopenia in combination with obesity showed greater association with adverse outcomes than that defined as an increased ratio of fat mass to muscle mass. A low prevalence rate of SO (< 10%) was associated with increased significance for adverse outcomes compared to the high prevalence rate of SO (> 20%).ConclusionThe SO was associated with increased complications and poor survival in gastrointestinal surgical oncology. Interventions aiming at SO have potentials to promote surgery benefits for patients with gastrointestinal cancers. The heterogeneity in SO definition and diagnosis among studies should be considered when interpreting these findings.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=255286], identifier [CRD42021255286].
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Affiliation(s)
- Peiyu Wang
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Shaodong Wang
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Yi Ma
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Haoran Li
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Zheng Liu
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Guihu Lin
- Department of Thoracic Surgery, China Aerospace Science and Industry Corporation 731 Hospital, Beijing, China
| | - Xiao Li
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
- *Correspondence: Fan Yang,
| | - Mantang Qiu
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
- Mantang Qiu,
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Yavuz S, Engin M. Preoperative predictors of postoperative atrial fibrillation in patients undergoing cardiopulmonary bypass. J Card Surg 2022; 37:1651-1653. [DOI: 10.1111/jocs.16406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/22/2022]
Affiliation(s)
- Senol Yavuz
- Department of Cardiovascular Surgery, Bursa Medical Faculty, Bursa Yuksek Ihtisas Training and Research Hospital University of Health Sciences Bursa Turkey
| | - Mesut Engin
- Department of Cardiovascular Surgery, Bursa Medical Faculty, Bursa Yuksek Ihtisas Training and Research Hospital University of Health Sciences Bursa Turkey
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12
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Liu Q, Wu M, Orgill DP, Bai X, Panayi AC. The effect of obesity on inpatient outcomes in lower extremity trauma: A systematic review and meta-analysis. J Trauma Acute Care Surg 2022; 92:464-470. [PMID: 34225344 DOI: 10.1097/ta.0000000000003328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obesity is a growing global health problem and a well-recognized risk factor for many medical conditions. This meta-analysis was conducted to assess the effect of obesity on overall complication occurrence, mortality, and hospital length of stay in patients with nonpathological lower limb trauma. METHODS The EMBASE, PUBMED, and MEDLINE electronic databases were searched from inception to April 1, 2020, for studies published in English. References cited by chosen studies were also checked manually for inclusion. Studies chosen for the analysis were prospective observational or retrospective cohort studies reporting on total complications of patients with acute traumatic, nonpathological, lower limb fractures that required internal fixation, with or without other underlying conditions. Two investigators independently reviewed the full text of eligible studies for inclusion and extracted data. Inconsistency was resolved through consultation with other authors. RESULTS Sixteen studies with 404,414 patients were investigated in this study. The data showed obesity was related with increased total complications (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.51-0.83; p < 0.01), increased wound complications (OR, 0.41; 95% CI, 0.25-0.66; p < 0.01), and increased mortality rate (OR, 0.64; 95% CI, 0.45-0.91; p < 0.05). Six cohort studies also showed prolonged hospital length of stay in obese patients. CONCLUSION Our results suggest that obesity is associated with increased complication and mortality rates, as well as longer hospital length of stay in patients with lower-limb trauma who required surgical treatment. These findings may raise attention to optimize surgical technique and develop individualized treatment for obese patients. LEVEL OF EVIDENCE Systematic reviews, level IV.
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Affiliation(s)
- Qinxin Liu
- From the Division of Plastic Surgery, Department of Surgery (Q.L., M.W., D.P.O., A.C.P.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Traumatic Surgery (Q.L., X.B.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei; and Department of Plastic Surgery (M.W.), Peking University Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
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Zhu Y, Jing W, Lv P, Zhu Y, Liu Z. Clinical factors associated with arrhythmia and short-term prognosis following mitral valve repair: a retrospective cohort study. Cardiovasc Diagn Ther 2022; 12:114-122. [PMID: 35282674 PMCID: PMC8898689 DOI: 10.21037/cdt-21-400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/25/2021] [Indexed: 01/18/2024]
Abstract
BACKGROUND Postoperative arrhythmia (POA) is one of the common and serious postoperative complications. This retrospective study was conducted to investigate the clinical factors associated with POA and its short-term prognosis following mitral valve repair. METHODS A total of 618 patients receiving mitral valve repair between January 2015 and November 2020 in our hospital were included in this retrospective study, including 318 males and 300 females and aged 53.9±9.3 years. The patients were grouped into arrhythmia and non-arrhythmia groups and investigated for risk factors associated with the prognosis of POA using multivariate logistic regression based on their clinical data. RESULTS POA was observed in 314 (50.8%) patients and atrial fibrillation (AF) was the most frequent (43.3%) type of POA. Compared with non-arrhythmia patients, arrhythmia patients had significantly longer time to use vasoactive drug use, longer intensive care unit (ICU) stay and longer hospital stay. In addition, the incidence of postoperative heart failure was significantly higher (P<0.05). Logistic regression analysis showed that preoperative arrhythmia [odds ratio (OR) =9.17; 95% confident interval (CI): 4.49-18.10], postoperative pain (OR =4.70; 95% CI: 1.55-6.12) and postoperative hypoxemia (OR =3.25; 95% CI: 1.04-6.28) were independently associated with POA. CONCLUSIONS This study demonstrates that the incidence of arrhythmia is relatively high after mitral valve repair and is associated with preoperative arrhythmia, postoperative pain and postoperative hypoxemia.
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Affiliation(s)
- Yuxiang Zhu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Wenbin Jing
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Pengfei Lv
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Yubao Zhu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Zhigang Liu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
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Low Voltage Potentials Contribute to Post-Operative Atrial Fibrillation Development in Obese Patients. Heart Rhythm 2022; 19:710-718. [DOI: 10.1016/j.hrthm.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/20/2022]
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15
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Peng S, Wang J, Yu H, Cao G, Liu P. Influence of Dexmedetomidine on Post-operative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials. Front Cardiovasc Med 2021; 8:721264. [PMID: 34901203 PMCID: PMC8655306 DOI: 10.3389/fcvm.2021.721264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/26/2021] [Indexed: 01/18/2023] Open
Abstract
Background: Previous clinical studies and meta-analysis evaluating the influence of dexmedetomidine on postoperative atrial fibrillation showed inconsistent results. We performed an updated meta-analysis to evaluate the influence of dexmedetomidine on incidence of postoperative atrial fibrillation after cardiac surgery. Methods: Randomized controlled trials that evaluated the potential influence of dexmedetomidine on the incidence of atrial fibrillation after cardiac surgery were obtained by search of PubMed, Embase, and Cochrane's Library databases from inception to April 12, 2021. A random-effects model incorporating the potential publication bias was used to pool the results. Influences of patient or study characteristics on the efficacy of dexmedetomidine on atrial fibrillation after cardiac surgery were evaluated by meta-regression and subgroup analyses. Results: Fifteen studies with 2,733 patients were included. Pooled results showed that dexmedetomidine significantly reduced the incidence of atrial fibrillation compared to control (OR: 0.72, 95% CI: 0.55–0.94, p = 0.02) with mild heterogeneity (I2 = 26%). Subgroup analysis showed that dexmedetomidine significantly reduced the incidence of atrial fibrillation in studies from Asian countries (OR: 0.41, 95% CI: 0.26–0.66, p < 0.001), but not in those from non-Asian countries (OR: 0.89, 95% CI: 0.71–1.10, p = 0.27; p for subgroup difference = 0.004). Meta-regression analysis showed that the mean age and proportion of male patients may modify the influence of dexmedetomidine on POAF (coefficient = 0.028 and 0.021, respectively, both p < 0.05). Subgroup analysis further showed that Dex was associated with reduced risk of atrial fibrillation after cardiac surgery in studies with younger patients (mean age ≤ 61 years, OR = 0.44, 95% CI: 0.28–0.69, p = 0.004) and smaller proportion of males (≤74%, OR = 0.55, 95% CI: 0.36–0.83, p = 0.005), but not in studies with older patients or larger proportion of males (p for subgroup difference = 0.02 and 0.04). Conclusions: Current evidence supports that perioperative administration of dexmedetomidine may reduce the risk of incidental atrial fibrillation after cardiac surgery, particularly in Asians.
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Affiliation(s)
- Sheng Peng
- Department of Anesthesiology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Juan Wang
- Department of Anesthesiology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Yu
- Department of Cardiovascular Surgery, Shanxi Fenyang Hospital, Fenyang, China
| | - Ge Cao
- Department of Cardiovascular Surgery, Shanxi Fenyang Hospital, Fenyang, China
| | - Peirong Liu
- Department of Anesthesiology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
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16
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Musa AF, Dillon J, Md Taib ME, Yunus AM, Sanusi AR, Nordin MN, Smith JA. A double-blind randomised controlled trial on the effect of Tocovid, a tocotrienol-rich capsule on postoperative atrial fibrillation at the National Heart Institute, Kuala Lumpur: an interim blinded analysis. J Cardiothorac Surg 2021; 16:340. [PMID: 34819126 PMCID: PMC8611632 DOI: 10.1186/s13019-021-01721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/06/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Post-operative atrial fibrillation (POAF) is associated with poorer outcomes, increased resource utilisation, morbidity and mortality. Its pathogenesis is initiated by systemic inflammation and oxidative stress. It is hypothesised that a potent antioxidant and anti-inflammatory agent such as tocotrienol, an isomer of Vitamin E, could reduce or prevent POAF. AIMS The aim of this study is to determine whether a potent antioxidative and anti-inflammatory agent, Tocovid, a tocotrienol-rich capsule, could reduce the incidence of POAF and affect the mortality and morbidity as well as the duration of ICU, HDU and hospital stay. METHODS This study was planned as a prospective, randomised, controlled trial with parallel groups. The control group received placebo containing palm superolein while the treatment group received Tocovid capsules. We investigated the incidence of POAF, the length of hospital stay after surgery and the health-related quality of life. RESULTS Recruitment commenced in January 2019 but the preliminary results were unblinded as the study is still ongoing. Two-hundred and two patients have been recruited out of a target sample size of 250 as of January 2021. About 75% have completed the study and 6.4% were either lost during follow-up or withdrew; 4% of participants died. The mean age group was 61.44 ± 7.30 years with no statistical difference between the groups, with males having a preponderance for AF. The incidence of POAF was 24.36% and the mean time for developing POAF was 55.38 ± 29.9 h post-CABG. Obesity was not a predictive factor. No statistically significant difference was observed when comparing left atrial size, NYHA class, ejection fraction and the premorbid history. The mean cross-clamp time was 71 ± 34 min and the mean bypass time was 95 ± 46 min, with no difference between groups. There was a threefold increase in death among patients with POAF (p = 0.008) and an increase in the duration of ICU stay (p = 0.01), the total duration of hospital stay (p = 0.04) and reintubation (p = 0.045). CONCLUSION A relatively low incidence rate of POAF was noted although the study is still ongoing. It remains to be seen if our prophylactic intervention using Tocovid would effectively reduce the incidence of POAF. Clinical Registration Number: US National Library of Medicine. Clinical Trials - NCT03807037. Registered on 16th January 2019. Link: https://clinicaltrials.gov/ct2/show/NCT03807037.
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Affiliation(s)
- Ahmad Farouk Musa
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
- Victorian Heart Institute, Monash University, Melbourne, Australia
| | | | | | | | | | | | - Julian A. Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
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Liu M, Mei K, Xie L, Ma J, Yu P, Niu S, Xu Y, Zhao Y, Liu X. Dose-response relationship among body mass index, abdominal adiposity and atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of 35 cohorts. PeerJ 2021; 9:e11855. [PMID: 34327066 PMCID: PMC8308618 DOI: 10.7717/peerj.11855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background Whether overweight increases the risk of postoperative atrial fibrillation (POAF) is unclear, and whether adiposity independently contributes to POAF has not been comprehensively studied. Thus, we conducted a meta-analysis to clarify the strength and shape of the exposure-effect relationship between adiposity and POAF. Methods The PubMed, Cochrane Library, and EMBASE databases were searched for revelant studies (randomized controlled trials (RCTs), cohort studies, and nest-case control studies) reporting data regarding the relationship between adiposity and the risk of POAF. Results Thirty-five publications involving 33,271 cases/141,442 patients were included. Analysis of categorical variables showed that obesity (RR: 1.39, 95% CI [1.21–1.61]; P < 0.001), but not being underweight (RR: 1.44, 95% CI [0.90–2.30]; P = 0.13) or being overweight (RR: 1.03, 95% CI [0.95–1.11]; P = 0.48) was associated with an increased risk of POAF. In the exposure-effect analysis (BMI) was 1.09 (95% CI [1.05–1.12]; P < 0.001) for the risk of POAF. There was a significant linear relationship between BMI and POAF (Pnonlinearity = 0.44); the curve was flat and began to rise steeply at a BMI of approximately 30. Notably, BMI levels below 30 (overweight) were not associated with a higher risk of POAF. Additionally, waist obesity or visceral adiposity index was associated with the risk of POAF. Conclusion Based on the current evidence, our findings showed that high body mass index or abdominal adiposity was independently associated with an increased risk of POAF, while underweight or overweight might not significantly increase the POAF risk.
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Affiliation(s)
- Menglu Liu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Kaibo Mei
- Anesthesiology Department,, the People's Hospital of Shanggrao, Shangrao, Jiangxi, China
| | - Lixia Xie
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, Oh, China
| | - Peng Yu
- Department of Endocrine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Siquan Niu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Ya Xu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Yujie Zhao
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou, China
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18
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Baoas SD, Rucinski J, Zenilman M. Investigational study of the clinical characteristics of confirmed COVID-19 cases. J Community Hosp Intern Med Perspect 2021; 11:450-456. [PMID: 34211647 PMCID: PMC8221131 DOI: 10.1080/20009666.2021.1926613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The COVID-19 is an emerging infectious disease that impacted HealthCare System worldwide and patients undergoing elective surgical procedures is associated with a high mortality rate and a complicated perioperative course. Methods: A retrospective observational study, the research design was conducted utilizing the RedCap ACS COVID-19 Registry and Cerner EMR. The intent of this design is to create statistical information about confirmed COVID-19 cases admitted in an academic institution in Brooklyn, New York from March to May 2020. Results: A total of 1413 patients were included in the final analysis. Of the 1413 patients, 520 Expired, 40.5% were males, and 33% were females, p = 0.004. Male patients had high mortality at a rate that is statistically significant. For race of those ‘Expired’, 38.3% white, 34.2% Black, 28.2% Asian, and Unknown 43.6%, showing statistical significance at p = 0.050. The most common co-morbidities for those not-Expired versus Expired: DM, 44.6% expired versus 55.6% not-expired, HTN, 77.1% versus 22.9%, and CAD, 47.9% versus 52.1%. Comparing the data of COVID-19 patients without surgery and with those who had surgery, it was observed that 53% of those who did not have surgery went ‘Home’ versus 38.6%, of those with surgery who could not. Further examining those without surgery versus those with surgery: 3.4% versus 13.3% discharge to ‘Rehab’, for ‘Other discharge’ destinations 5.9% versus 14.5%, and for ‘Expired’ 37.1% versus 31.3%. Overall, the presence of surgery had a significant impact on COVID-19 patients discharge destinations at p = < 0.001. Conclusions: The implications of change in the setting of our current clinical practice therefore require forbearance, training, preparedness, and education to efficiently maintain our essential surgical services.
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Affiliation(s)
- Sharon Desales Baoas
- Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - James Rucinski
- Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Michael Zenilman
- Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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19
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Cheng Z, Wang L, Sun X. Does overweight really play protective role in elderly patients after cardiac surgery? J Thorac Dis 2021; 13:3186-3187. [PMID: 34164209 PMCID: PMC8182531 DOI: 10.21037/jtd-21-482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zeyi Cheng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Luchen Wang
- Aortic and Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaogang Sun
- Aortic and Vascular Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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20
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Stefàno PL, Bugetti M, Del Monaco G, Popescu G, Pieragnoli P, Ricciardi G, Perrotta L, Checchi L, Rondine R, Bevilacqua S, Fumagalli C, Marchionni N, Michelucci A. Overweight and aging increase the risk of atrial fibrillation after cardiac surgery independently of left atrial size and left ventricular ejection fraction. J Cardiothorac Surg 2020; 15:316. [PMID: 33059687 PMCID: PMC7559788 DOI: 10.1186/s13019-020-01366-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/05/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Body mass index (BMI), age, left atrium (LA) dimension and left ventricular ejection fraction (LVEF) have been linked to post-operative atrial fibrillation (POAF) after cardiac surgery. The aim of this study was to better define the role of these risk factors. METHODS This retrospective cohort study evaluated 249 patients (without prior atrial dysrhythmia) undergoing cardiac or aortic surgery. Prior to surgery, the following data were collected: age, BMI, LA diameter, LA area, LVEF, thyroid stimulating hormone (TSH), creatinine and the presence of arterial hypertension (AH) and diabetes. Intraoperative data such as operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion were also collected. Only patients without pre- and post-surgery prophylactic anti-arrhythmic therapy were included. RESULTS Patients with (N = 127, 51%) and without POAF (N = 122, 49%) were compared. No difference was observed for sex, LA diameter, LA area, LVEF, TSH, diabetes and use of ACE inhibitors or statins prior to intervention. Moreover, no difference was observed in terms of operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion. However, patients with POAF were older (70.6 ± 10.7 vs. 60.4 ± 16.4 years, p = 0.001), had higher BMI (26.8 ± 4.5 vs. 24.9 ± 3.6 kg/m2, p = 0.001), higher baseline creatinine (1.06 ± 0.91 vs. 0.88 ± 0.32 mg/dL, p = 0.038) and a higher frequency of arterial hypertension (73.2% vs. 50%, p = 0.001) and Bentall procedure (24.4% vs. 9.8%, p = 0.023). Multivariate analysis showed that the only independent predictors of POAF were age (OR = 1.05, 95%CI 1.02-1.07, p = 0.001) and BMI (OR = 1.11 95%CI 1.03-1.2,p = 0.006). CONCLUSIONS These findings suggest that advanced age and a higher BMI are strong risk factors for POAF in patients without previous AF even in the presence of comparable LA dimensions and LVEF.
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Affiliation(s)
- Pier Luigi Stefàno
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, Florence, 50134, Italy
| | - Marco Bugetti
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
| | - Guido Del Monaco
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
| | - Gloria Popescu
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
| | - Paolo Pieragnoli
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
| | - Giuseppe Ricciardi
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
| | - Laura Perrotta
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
| | - Luca Checchi
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
| | - Roberto Rondine
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
| | - Sergio Bevilacqua
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
| | - Carlo Fumagalli
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, Florence, 50134, Italy
| | - Niccolò Marchionni
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, Florence, 50134, Italy
| | - Antonio Michelucci
- Department of Cardiothoracovascular Medicine, Careggi University Hospital (AOUC), Largo Brambilla, 3, 50134, Florence, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, Florence, 50134, Italy.
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Schram-Serban C, Heida A, Roos-Serote MC, Knops P, Kik C, Brundel B, Bogers AJJC, de Groot NMS. Heterogeneity in Conduction Underlies Obesity-Related Atrial Fibrillation Vulnerability. Circ Arrhythm Electrophysiol 2020; 13:e008161. [PMID: 32301327 DOI: 10.1161/circep.119.008161] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obese patients are more vulnerable to development of atrial fibrillation but pathophysiology underlying this relation is only partly understood. The aim of this study is to compare the severity and extensiveness of conduction disorders between obese patients and nonobese patients measured at a high-resolution scale. METHODS Patients (N=212) undergoing cardiac surgery (male:161, 63±11 years) underwent epicardial mapping of the right atrium, Bachmann bundle, and left atrium during sinus rhythm. Conduction delay (CD) was defined as interelectrode conduction time of 7 to 11 ms and conduction block (CB) as conduction time ≥12 ms. Prevalence of CD/CB, continuous CDCB (cCDCB), length of CD/CB/cCDCB lines, and severity of CB were analyzed. RESULTS In obese patients, the overall incidence of CD (3.1% versus 2.6%; P=0.002), CB (1.8% versus 1.2%; P<0.001), and cCDCB (2.6% versus 1.9%; P<0.001) was higher and CD (P=0.012) and cCDCB (P<0.001) lines are longer. There were more conduction disorders at Bachmann bundle and this area has a higher incidence of CD (4.4% versus 3.3%, P=0.002), CB (3.1% versus 1.6%, P<0.001), cCDCB (4.6% versus 2.7%, P<0.001) and longer CD (P<0.001) or cCDCB (P=0.017) lines. The severity of CB is also higher, particularly in the Bachmann bundle (P=0.008) and pulmonary vein (P=0.020) areas. In addition, obese patients have a higher incidence of early de-novo postoperative atrial fibrillation (P=0.003). Body mass index (P=0.037) and the overall amount of CB (P=0.012) were independent predictors for incidence of early postoperative atrial fibrillation. CONCLUSIONS Compared with nonobese patients, obese patients have higher incidences of conduction disorders, which are also more extensive and more severe. These differences in heterogeneity in conduction are already present during sinus rhythm and may explain the higher vulnerability to atrial fibrillation of obese patients.
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Affiliation(s)
- Corina Schram-Serban
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Annejet Heida
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Maarten C Roos-Serote
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Paul Knops
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
| | - Charles Kik
- Department of Cardio-Thoracic Surgery (C.K., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam
| | - Bianca Brundel
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam (B.B.).,Cardiovascular Sciences, Amsterdam, The Netherlands (B.B.)
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery (C.K., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam
| | - Natasja M S de Groot
- Department of Cardiology (C.S.-S., A.H., M.C.R.-S., P.K., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam
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Khan MS, Yamashita K, Sharma V, Ranjan R, Dosdall DJ. RNAs and Gene Expression Predicting Postoperative Atrial Fibrillation in Cardiac Surgery Patients Undergoing Coronary Artery Bypass Grafting. J Clin Med 2020; 9:jcm9041139. [PMID: 32316120 PMCID: PMC7231013 DOI: 10.3390/jcm9041139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023] Open
Abstract
Postoperative atrial fibrillation (POAF) is linked with increased morbidity, mortality rate and financial liability. About 20–50% of patients experience POAF after coronary artery bypass graft (CABG) surgery. Numerous review articles and meta-analyses have investigated links between patient clinical risk factors, demographic conditions, and pre-, peri- and post-operative biomarkers to forecast POAF incidence in CABG patients. This narrative review, for the first time, summarize the role of micro-RNAs, circular-RNAs and other gene expressions that have shown experimental evidence to accurately predict the POAF incidence in cardiac surgery patients after CABG. We envisage that identifying specific genomic markers for predicting POAF might be a significant step for the prevention and effective management of this type of post-operative complication and may provide critical perspective into arrhythmogenic substrate responsible for POAF.
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Affiliation(s)
- Muhammad Shuja Khan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT 84112, USA; (M.S.K.); (K.Y.); (R.R.)
| | - Kennosuke Yamashita
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT 84112, USA; (M.S.K.); (K.Y.); (R.R.)
- Division of Cardiovascular Medicine, The University of Utah-Health, Salt Lake City, UT 84132, USA
| | - Vikas Sharma
- Division of Cardiothoracic Surgery, The University of Utah-Health, Salt Lake City, UT 84132, USA;
| | - Ravi Ranjan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT 84112, USA; (M.S.K.); (K.Y.); (R.R.)
- Division of Cardiovascular Medicine, The University of Utah-Health, Salt Lake City, UT 84132, USA
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, UT 84112, USA
| | - Derek James Dosdall
- Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT 84112, USA; (M.S.K.); (K.Y.); (R.R.)
- Division of Cardiovascular Medicine, The University of Utah-Health, Salt Lake City, UT 84132, USA
- Division of Cardiothoracic Surgery, The University of Utah-Health, Salt Lake City, UT 84132, USA;
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, UT 84112, USA
- Correspondence: ; Tel.: +1-801-587-2036
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23
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Dwivedi AK, Dubey P, Cistola DP, Reddy SY. Association Between Obesity and Cardiovascular Outcomes: Updated Evidence from Meta-analysis Studies. Curr Cardiol Rep 2020; 22:25. [DOI: 10.1007/s11886-020-1273-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Agrimi J, Baroni C, Anakor E, Lionetti V. Perioperative Heart-Brain Axis Protection in Obese Surgical Patients: The Nutrigenomic Approach. Curr Med Chem 2020; 27:258-281. [PMID: 30324875 DOI: 10.2174/0929867325666181015145225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/01/2018] [Accepted: 09/25/2018] [Indexed: 02/06/2023]
Abstract
The number of obese patients undergoing cardiac and noncardiac surgery is rapidly increasing because they are more prone to concomitant diseases, such as diabetes, thrombosis, sleep-disordered breathing, cardiovascular and cerebrovascular disorders. Even if guidelines are already available to manage anesthesia and surgery of obese patients, the assessment of the perioperative morbidity and mortality from heart and brain disorders in morbidly obese surgical patients will be challenging in the next years. The present review will recapitulate the new mechanisms underlying the Heart-brain Axis (HBA) vulnerability during the perioperative period in healthy and morbidly obese patients. Finally, we will describe the nutrigenomics approach, an emerging noninvasive dietary tool, to maintain a healthy body weight and to minimize the HBA propensity to injury in obese individuals undergoing all types of surgery by personalized intake of plant compounds that may regulate the switch from health to disease in an epigenetic manner. Our review provides current insights into the mechanisms underlying HBA response in obese surgical patients and how they are modulated by epigenetically active food constituents.
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Affiliation(s)
- Jacopo Agrimi
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Carlotta Baroni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Ekene Anakor
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Vincenzo Lionetti
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,UOS Anesthesiology, Fondazione Toscana G. Monasterio, Pisa, Italy
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Ali H, Cappato R. Commentary: Obesity and cardiac surgery-Double trouble for the surgeon and arrhythmologist. J Thorac Cardiovasc Surg 2019; 159:939-940. [PMID: 31126652 DOI: 10.1016/j.jtcvs.2019.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Hussam Ali
- Arrhythmia & EP Research Center, IRCCS Humanitas Research & University Hospital, Milan, Italy.
| | - Riccardo Cappato
- Arrhythmia & EP Research Center, IRCCS Humanitas Research & University Hospital, Milan, Italy
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Li S, Che G, Liu L, Chen L. Does the "obesity paradox" really exist in lung cancer surgery? -maybe we should recognize what is the "obesity" first. J Thorac Dis 2019; 11:S291-S295. [PMID: 30997201 DOI: 10.21037/jtd.2019.01.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Longqi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Serban C, Arinze JT, Starreveld R, Lanters EAH, Yaksh A, Kik C, Acardag Y, Knops P, Bogers AJJC, de Groot NMS. The impact of obesity on early postoperative atrial fibrillation burden. J Thorac Cardiovasc Surg 2019; 159:930-938.e2. [PMID: 31043315 DOI: 10.1016/j.jtcvs.2019.03.073] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Obesity has been linked to the development of postoperative atrial fibrillation. This study is aimed at investigating the role of body mass index in the evolution of de novo, early postoperative atrial fibrillation by assessing differences between obese and nonobese patients undergoing cardiac surgery. METHODS Patients with early de novo postoperative atrial fibrillation were included. Continuous cardiac rhythms were recorded during the first 5 postoperative days in obese (N = 67, 66 ± 9 years; 51 [76%] male) and nonobese (N = 89, 69 ± 9; 75 [84%] male) patients without a history of atrial fibrillation undergoing cardiac surgery. Postoperative atrial fibrillation burden was defined as the ratio between total duration of all atrial fibrillation episodes and total recording time (atrial fibrillation burden, %). RESULTS A total of 1191 (median: 5/patient) postoperative atrial fibrillation episodes were identified in the obese group compared with 1218 (median: 4/patient) in the nonobese group. The median duration and number of prolonged (>60 minutes) postoperative atrial fibrillation episodes were higher in obese patients (250 vs 145 minutes, P = .003, and median of 2 vs 1 episode, P = .031). Obesity was associated with a larger early postoperative atrial fibrillation burden (obese patients: median, 7%; interquartile range, 2.5-19.7 vs nonobese patients: median, 3.2%; interquartile range, 0.5-8.8, P = .001) mainly on the third postoperative day (P = .021). CONCLUSIONS Obesity predisposes to a larger number of prolonged atrial fibrillation episodes in the early postoperative period after cardiac surgery for coronary artery disease or valvular heart disease. The higher atrial fibrillation burden in the early postoperative period occurred particularly on the third day. Future studies will determine whether obesity prevention may play a key role in reducing the incidence of postoperative atrial fibrillation in patients undergoing cardiac surgery.
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Affiliation(s)
- Corina Serban
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johnmary T Arinze
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Roeliene Starreveld
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eva A H Lanters
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ameeta Yaksh
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Charles Kik
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yalin Acardag
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Shah SR, Luu SW, Calestino M, David J, Christopher B. Management of atrial fibrillation-flutter: uptodate guideline paper on the current evidence. J Community Hosp Intern Med Perspect 2018; 8:269-275. [PMID: 30357020 PMCID: PMC6197036 DOI: 10.1080/20009666.2018.1514932] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/14/2018] [Indexed: 02/08/2023] Open
Abstract
The term 'flutter' and 'fibrillation' were first coined to differentiate the differences between fast, regular contractions in Atrial Flutter (AFLUT) with irregular, vermiform contractions of Atrial Fibrillation (AFIB). Management of these two diseases has been a challenge for physicians. Rate control (along with rhythm control) is the first line of management for symptomatic AFIB/AFLUT with Rapid Ventricular Rate (RVR). In some situations, atrial rhythms may not be well controlled by these anti-arrhythmic drugs, making cardioversion to sinus rhythm necessary. Anti-coagulation therapy in both the disease population is essential. Catheter ablation is an effective treatment option in certain patients that have AFIB/AFLUT refractory to medical management. Newer techniques like left atrial appendage (LAA) has been developed and is a highly attractive concept for the future in the management of AFIB/AFLUT. Newer novel drugs targeting specific ion channels are approaching the stages of clinical investigation. However, while advances in technologies have helped elucidate many aspects of these diseases, many mysteries still remain. This literature review serves as one of the guideline papers for current up-to-date management on both AFIB and AFLUT.
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Affiliation(s)
- Syed Raza Shah
- North Florida Regional Medical Center, University of Central Florida (Gainesville), Gainesville, FL, USA
| | - Sue-Wei Luu
- Graduate Medical Education, University of Central Florida College of Medicine, Gainesville, FL, USA
| | - Matthew Calestino
- Graduate Medical Education, University of Central Florida College of Medicine, Gainesville, FL, USA
| | - John David
- Graduate Medical Education, University of Central Florida College of Medicine, Gainesville, FL, USA
| | - Bray Christopher
- Graduate Medical Education, University of Central Florida College of Medicine, Gainesville, FL, USA
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Deng H, Shantsila A, Guo P, Potpara TS, Zhan X, Fang X, Liao H, Liu Y, Wei W, Fu L, Wu S, Xue Y, Lip GYH. A U-shaped relationship of body mass index on atrial fibrillation recurrence post ablation: A report from the Guangzhou atrial fibrillation ablation registry. EBioMedicine 2018; 35:40-45. [PMID: 30174278 PMCID: PMC6156736 DOI: 10.1016/j.ebiom.2018.08.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/08/2018] [Accepted: 08/15/2018] [Indexed: 12/25/2022] Open
Abstract
Background Obesity or overweight is related to worse outcomes in patients with atrial fibrillation (AF) following catheter ablation (CA). The role of being underweight in relation to recurrent arrhythmias post AF ablation is less certain. We conducted a retrospective study to investigate the association of body mass index (BMI) with arrhythmia outcomes in AF patients undergoing CA. Methods In a cohort of 1410 AF patients (mean age 57.2 ± 11.6 years; 68% male) undergoing single CA, the association between BMI and AF ablation outcome was analyzed using BMI as a continuous variable and by four BMI categories (<18.5 kg/m2, 18.5-24 kg/m2, 25-29 kg/m2, and ≥ 30 kg/m2). Result We observed a positive association between a cut off value of BMI and risk of AF recurrence post AF ablation. BMI ≥26.36 kg/m2 was related to more AF recurrence (c-statistic 0.55, 95%CI 0.51–0.58; P < 0.01) with 50% increased risk of AF recurrence (HR 1.50, 95% CI 1.22–1.86; P < 0.01). Recurrence rates in the four BMI categories were 33.3%, 23.2%, 27.2 and 41.8%, respectively (P < 0.01). Kaplan-Meier analysis showed that BMI categories of <18.5 kg/m2 and ≥ 30 kg/m2 were all associated with more AF recurrence (P = 0.01). Both underweight (HR 1.85, 95%CI 1.12–3.08; P = 0.02) and obesity (HR 1.78, 95%CI 1.17–2.72; P = 0.01) significantly increased the risk of AF recurrence in a Cox proportional hazard model. Conclusion BMI had good predictive value for AF ablation outcomes with a cut off value of ≥26.36 kg/m2. Apart from being obese/overweight, being underweight might also be a risk factor for AF recurrence post ablation.
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Affiliation(s)
- Hai Deng
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Alena Shantsila
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom
| | - Pi Guo
- Department of Public Health, Medical College of Shantou University, Shantou, China
| | | | - Xianzhang Zhan
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Xianhong Fang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Hongtao Liao
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Yang Liu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Wei Wei
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Lu Fu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Nakadate Y, Sato H, Sato T, Codere-Maruyama T, Matsukawa T, Schricker T. Body mass index predicts insulin sensitivity during cardiac surgery: a prospective observational study. Can J Anaesth 2018; 65:551-559. [DOI: 10.1007/s12630-018-1081-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/28/2017] [Accepted: 12/30/2017] [Indexed: 01/08/2023] Open
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Lu R, Ma N, Jiang Z, Mei J. Endothelin-1 is associated with dilatation of the left atrium and can be an independent predictor of atrial fibrillation after mitral valve surgery. Interact Cardiovasc Thorac Surg 2017; 26:66-70. [DOI: 10.1093/icvts/ivx250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/03/2017] [Indexed: 11/13/2022] Open
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Chan W, Baranchuk A. Life-style modification at the edge. J Thorac Dis 2017; 9:1811-1813. [PMID: 28839971 PMCID: PMC5542936 DOI: 10.21037/jtd.2017.06.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 06/11/2017] [Indexed: 08/30/2023]
Affiliation(s)
- Winnie Chan
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF. Surgical approaches have also been developed for treatment of AF, particularly for patients requiring concomitant cardiac surgery or those refractory to medical and catheter ablation treatments. Since the introduction of the Cox-Maze III, this procedure has evolved into several modern variations, including the use of alternative energy sources (Cox-Maze IV) such as radiofrequency, cryo-energy and microwave, as well as minimally invasive thoracoscopic epicardial approaches. Another recently introduced technique is the hybrid ablation approach, where in a single setting both epicardial thoracoscopic ablation lesions and endocardial catheter ablation lesions are performed by the cardiothoracic surgeon and cardiologist. There remains controversy surrounding the optimal approach for AF ablation, energy sources, and lesion sets employed. The goal of this article is review the history, classifications, pathophysiology and current treatment options for AF.
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Affiliation(s)
- Joshua Xu
- Sydney Medical School, University of Sydney, Sydney, Australia;; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Jessica G Y Luc
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Kevin Phan
- Sydney Medical School, University of Sydney, Sydney, Australia;; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia;; Faculty of Medicine, University of New South Wales, Sydney, Australia
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Ergün G, Başaran Ö, Doğan V, Doğan MM, Biteker M. Obesity and atrial fibrillation. Int J Cardiol 2016; 223:159-160. [PMID: 27544592 DOI: 10.1016/j.ijcard.2016.08.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/03/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Gökhan Ergün
- Muğla University, Faculty of Medicine, Department of Cardiology, Turkey.
| | - Özcan Başaran
- Muğla University, Faculty of Medicine, Department of Cardiology, Turkey
| | - Volkan Doğan
- Muğla University, Faculty of Medicine, Department of Cardiology, Turkey
| | | | - Murat Biteker
- Muğla University, Faculty of Medicine, Department of Cardiology, Turkey
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